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Therapeutic pearl
Topical timolol for chronic wounds in patients with junctional epidermolysis bullosa

https://doi.org/10.1016/j.jaad.2016.08.005Get rights and content

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Therapeutic challenge

Junctional epidermolysis bullosa (JEB) is characterized by skin cleavage occurring within the lamina lucida of the basement membrane zone. Patients with the generalized intermediate subtype of JEB have relatively mild skin fragility but develop painful chronic wounds in the periorificial areas, nail beds, and flexures because of mutations in one of the genes encoding for laminin 332. Topical steroids are usually applied, but this treatment is often insufficient.

Solution

Two 1-year-old children with the generalized intermediate subtype of JEB had chronic wounds of the nail bed and neck fold, respectively, despite the daily application of potent topical steroids and protection with silicone dressing for >2 months. After 3 and 8 weeks of twice daily topical application of 2 and 3 timolol maleate 0.5% LP eye drops under occlusion (Mepiform; Mölnlycke Health Care, Norcross, GA), respectively, healing was obtained at 100% and 80% (Fig 1). No adverse effects were

References (2)

  • L.R. Braun et al.

    Topical timolol for recalcitrant wounds

    JAMA Dermatol

    (2013)
  • M.R. Dasu et al.

    Crosstalk between adrenergic and toll-like receptors in human mesenchymal stem cells and keratinocytes: a recipe for impaired wound healing

    Stem Cells Transl Med

    (2014)

Funding sources: None.

Conflicts of interest: None declared.

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